Cardiovascular Critical Care I
According to outlying hospital records, only 30 mL
of urine was reported before time of transfer.
| • | His chest radiography reveals evidence of diffuse |
|---|
patchy opacities; however, the report indicates that
an infiltrate cannot be ruled out.
| • | His serum chemistry panel results are as follows: |
|---|
sodium 132 mEq/L, potassium 4.2 mEq/L, chloride
102 mEq/L, carbon dioxide 22 mEq/L, blood urea
nitrogen (BUN) 34 mg/dL, serum creatinine (SCr)
1.9 mg/dL, and glucose 163 mg/dL.
| • | Results of the complete blood cell count (CBC) are |
|---|
as follows: white blood cell count (WBC) 11.3 ×
103 cells/mm3, hemoglobin 10.9 g/dL, hematocrit
31.1%, and platelet count 213,000/mm3.
| • | Additional laboratory values include troponin-T |
|---|
3.9 ng/mL, aspartate aminotransferase (AST) 14
IU/L, alanine aminotransferase (ALT) 46 IU/L,
hemoglobin A1C (A1C) 8.3%, and brain natriuretic
peptide (BNP) of 1423 pg/mL.
Which is the most likely cause of this patient’s
admission and transfer?
with subsequent myocardial depression and
demand ischemia.
decompensated systolic heart failure (HF).
inferior ST-segment elevation myocardial
infarction (STEMI).
ST-segment elevation myocardial infarction
(NSTEMI) affecting the lateral wall.
artery is most likely to be the culprit lesion?
The interventional cardiologist who is evaluating
the patient for potential revascularization asks the
ICU team to place a central venous catheter. Which
changes/interventions regarding this patient’s hemo-
dynamic support would be best to recommend?
pressure (MAP) greater than 65 mm Hg.
titrate the dose to achieve a MAP greater than
65 mm Hg while weaning off dopamine.
continue dopamine at 15 mcg/kg/minute.
because of low urine output.
The patient has been taken to the cardiac cath-
eterization laboratory, and a “code blue” is called
overhead for immediate emergency response to this
patient’s procedural area. On arrival, chest com-
pressions have just been paused for defibrillation,
and a single dose of epinephrine has been admin-
istered. The interventional team indicates that,
when attempting visualization of the right coronary
artery, the patient went into ventricular tachycardia
(VT). The patient’s telemetry monitor now shows
sinus tachycardia with noted ectopy—heart rate
113 beats/minute and blood pressure 84/52 mm Hg.
The cardiologist asks for recommendations for an
antiarrhythmic because he is concerned about a VT
recurrence, given the bigeminy on telemetry. Which
agent would be best to recommend?
minutes, followed by an infusion at 1 mg/
minute.
than 1 minute.
minutes.
utes, followed by a continuous infusion at 5
mg/hour and titrated to maintain a heart rate
less than 110 beats/minute.
The patient returns to the ICU after his left heart
catheterization, which was performed through the
femoral artery. In addition to his acute decompen-
sation, which major procedural complication is of
greatest concern during the next 12 hours?